| NPI | 1497322408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CO APN.0996672-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.0130031) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2024-03-28 |